Provider Demographics
NPI:1962668491
Name:MENTAL HEALTH CARE ASSOC
Entity Type:Organization
Organization Name:MENTAL HEALTH CARE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:308-432-2133
Mailing Address - Street 1:343 CHADRON AVE
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337
Mailing Address - Country:US
Mailing Address - Phone:308-432-2133
Mailing Address - Fax:308-432-2133
Practice Address - Street 1:343 CHADRON AVE
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337
Practice Address - Country:US
Practice Address - Phone:308-432-2133
Practice Address - Fax:308-432-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE378101YM0800X
NE412101YP2500X
NE38106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid